Chairperson, Ministers and Deputy Ministers present here today, my colleague, the Deputy Minister of Health, Dr Gwen Ramokgopa, MECs from the various provinces, hon chairperson of the portfolio committee, Dr Monwabisi Goqwana, and members of your committee, hon members of the House, the Director-General of Health, Ms Precious Matsoso, Your Excellencies, High Commissioners and Ambassadors, leaders of the various statutory bodies, health unions and other health-related organisations, our special guest, the Roll Back Malaria and Unicef Goodwill Ambassador and UN Envoy for Africa, Ms Yvonne Chaka Chaka, distinguished guests, ladies and gentlemen, it is a great honour and privilege to present to this House the national Department of Health's policy priorities and budgets for the financial year 2012-13 for your consideration.
This period falls in the mid-term of our office. It is very important for me to do some form of review of our health care system. This will shape our understanding of how we can protect and maximise our gains for the remaining half of the term. We started the term by putting forward a 10- point plan, which you are familiar with by now.
The Department of Health's outcome is "A long and healthy life for all South Africans". It is one of the 12 outcomes of government. This "long and healthy life" is not going to be achieved through wishes or sloganeering. It is not going to roll in on the wheels of inevitability. There has to be a well-thought-out and well-executed plan to achieve this. We have selected four outputs that must be achieved to realise the goal of a long and healthy life for all South Africans.
The first output is to improve the life expectancy of all South Africans. We all know that the life expectancy figures in our country have taken a serious knock as a result of the quadruple burden of disease, or the four pandemics, that the country is experiencing. These four pandemics, as you know, are the scourge of HIV/Aids and tuberculosis; the unacceptably high incidence of maternal and child mortality; the ever-expanding burden of noncommunicable diseases and the high incidence of violence and injury, including motor vehicle accidents.
We need to do everything in our power as a country to defeat the four pandemics, hence our second output is decreasing maternal and child mortality. The third output is dealing with the scourge of HIV/Aids and tuberculosis.
Chairperson, to facilitate on understanding of what I am trying to convey to this House, please allow me to deal with these first three outputs, before I even mention the fourth one. I have a special reason for doing so, and I will explain it later as I go along.
With regard to the issue of HIV/Aids and tuberculosis, as a country we started the early decades of HIV/Aids on the wrong foot, but recently, in typical South African style, we have bounced back. We have shown that a common goal and collaboration and solidarity against a shared threat is desired and can produce results.
Through our combined efforts and collaborative undertakings, we launched a huge campaign to test and counsel 15 million South Africans with regard to HIV. We have achieved this and even exceeded the target, and today more than 20 million South Africans know their status.
Through this programme, we have been able to counsel and place 1,6 million South Africans on antiretroviral treatment. We have achieved this by increasing ARV sites from 490 in February 2010 to 3 000 in April 2012. We have increased the number of nurses certified to initiate ARV treatment from 250 in February 2010, to 10 000 in April 2012.
Within the same period, we conducted 320 000 medical male circumcisions. We have reduced mother-to-child transmission of HIV from 8% in 2008 to 3,5% in 2011, or even to 2,5%, in the case of KwaZulu-Natal. This is a reduction of 50%.
This success has allowed us to save 30 000 babies from contracting HIV from their mothers. In order not to be complacent, we have unveiled a new National Strategic Plan on HIV/Aids and tuberculosis for the period 2012- 16. This strategic plan was officially launched by President Jacob Zuma on World Aids Day last year.
The provincial implementation programme was launched by Deputy President Kgalema Motlanthe on World TB Day on 24 March this year. For the first time in the history of our country, we have integrated HIV/Aids and tuberculosis in the same strategic plan. This new plan outlines a 20-year vision for the country in the fight against the double scourge of HIV/Aids and tuberculosis.
Hon members, we need your support and leadership to make the four strategic objectives in the country's National Strategic Plan a success. These four strategic objectives are: addressing the social structural drivers of HIV, sexually transmitted diseases, as well as tuberculosis care, prevention and support; preventing new HIV, STD and tuberculosis infections; sustaining health and wellness; and, lastly, ensuring the protection of human rights and improving access to justice.
The new National Strategic Plan further requires that every South African must be tested at least once a year. We believe that if all South Africans can play their role, these goals will be achieved. We need to make sure that every pregnant woman undergoes routine HIV-testing. We need to make sure every male is circumcised and so, this year, we are targeting 600 000 men.
The problems of the high maternal and child mortality rate, high rates of pregnancy-related deaths, the disproportionate number of women exposed to sexual violence - with the worst incident of all shaming the country just this past week - are cause for concern.
You will have noted that most of our interventions on HIV/Aids are directed at saving pregnant women and children. It is important to note that maternal mortality is not just the death of a woman, it is the death of a woman because she dared to fall pregnant. She runs the risk of dying because she is trying to bring new life into this world.
We know that even mortality as a result of HIV/Aids, as well as malaria, is disproportionally affecting young women of child-bearing age. This disproportionate assault on women of child-bearing age is happening more on the continent of Africa than in any other part of the world. Therefore the African Union came up with a programme called the Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa, or Carmma. In our country, we will launch Carmma on 4 2012 May, at the Osindisweni Hospital in the province of KwaZulu-Natal. Members of the portfolio committee have been invited to this event through their chairperson. We will outline concrete steps to reduce the maternal and child mortality rate during that event. During that event we will elaborate further on how we shall roll out the strategy called the Essential Steps in Managing Obstetric Emergencies and the strategy called Emergency Obstetric Simulation Training.
The output on increasing life expectancy, which is our first output, does not only depend on our fight against HIV/Aids and reducing maternal and child mortality but also depends largely on bringing noncommunicable diseases under control and decreasing the scourge of violence as well as injuries on our roads. Until very recently, the issue of noncommunicable diseases was not spoken about much in the public arena. Many people didn't understand it, though it preceded HIV/Aids by several decades. This is because, unlike the NCDs, HIV/Aids arrived abruptly and brutally on this planet. It came as such a shock to the world that many strong civil society groups were formed to deal with it.
This is why there is a measure of success in the battle against HIV/Aids. The NCDs, as the name implies, are not transmitted from one person to the another by a germ or a biological agent. They are not only biomedical but, by and large, lifestyle diseases.
They are divided into four categories and have four identifiable risk factors. I advise people to remember them as the 4X4s, because there are four categories with four risk factors. These categories are: high blood pressure and other diseases of the heart and blood vessels; diabetes mellitus and a few other metabolic disorders; chronic respiratory diseases like asthma; and cancer.
We would like to add mental health as a problem that falls within these categories. The four risks factors, as you know and I will keep on reminding you, are: smoking, excessive use of alcohol, unhealthy eating behaviour or poor diet and a continued lack of physical exercise - and these risks can be repeated 10 times over. The President spoke about these problems in the state of the nation address, when he advised us not to allow our bodies to bulge uncontrollably, as many of us are unfortunately prone to doing. [Laughter.]
We are going to announce far-reaching measures to deal with these risk factors. The United Nations General Assembly took a resolution on these issues in September last year. The measures we will announce will leave no sacred cows untouched, and that includes alcohol control, an issue in regard to which some have attempted to intimidate us never to mention it, just as they have tried to intimidate us in regard to the issue of tobacco and tobacco products. The fourth output is improving the efficiency and effectiveness of the health care system. Chairperson, I promised earlier that I would raise the fourth outcome after I had mentioned the other three. The fourth outcome merits special attention in its own right because of the extraordinary challenges we are faced with in this area. In fact, in recent days, whenever South Africans have been talking about health, they have mostly referred to the efficiency and effectiveness of the health care system, or the inefficiency and ineffectiveness of the health care system.
We have identified five areas of activity, or five programmes. The first is the improvement of infrastructure. The second is the issue of human resources, its planning, development and management. The third is the quality of health care in our institutions. The fourth is the re- engineering of primary health care. The fifth is the cost of health care. The much-talked-about National Health Insurance, falls within the last programme category. Due to a lack of time, I will deal with only two of these problems today, namely the issue of quality in our public facilities and the issue of the NHI.
The President addressed this issue during the state of the nation address when he said, and I quote:
Fellow South Africans, we are seriously concerned about the deterioration of the quality of health care, aggravated by the steady increase in the burden of disease in the past decade and a half.
We haven't rested on our laurels since that time. We also did not want to work on the basis of anecdotes or common sense in dealing with quality. Therefore we embarked on a process of health-facility audits. This entails sending teams to all of the 4 200 public health facilities to audit their infrastructure, human resources, cleanliness, attitude of staff, safety and security of staff, infection control, drug stock-outs and the long queues that citizens have to endure when visiting our facilities.
Since we have completed 90% of the audit process, we think we fully comprehend the nature of the problems. Therefore we have put together four health facility improvement teams to go to these facilities and work with the provincial management in order to correct all the anomalies and findings identified during the audits.
The teams have already started working in Motheo District in the Free State, Sedibeng in Gauteng, Zululand in KwaZulu-Natal and Pixley ka Seme in the Northern Cape. The portfolio committee is busy going through the draft legislation we have presented to it to establish the Office of Health Standards Compliance. This office will deal with the issues of quality as described above, without fear or favour. I would like to repeat this, Chairperson: We would like the Office of Health Standards Compliance to deal with issues of health standards without fear or favour.
On the topic of the NHI, there is no way on efficient and effective health care system can ever be realised without dealing with the cost of health care and health care financing. There are people who wrongly believe that the concept of health care financing, as envisaged in the NHI, is a pipe dream concocted by the ANC government. I wish to advise them that the NHI is not just a unique South African concept. The World Health Organisation is actively promoting this concept and describes it as "universal health coverage". Universal health coverage is a system that does not discriminate against any citizen of a country.
Let me quote from a presentation given by Dr Margaret Chan, the Director- General of the WHO, on 2 April - three weeks ago - in Mexico, where she was addressing a conference on this issue.
Her presentation was titled "More countries move towards universal health coverage". She said: This was the tipping point, when the world woke up to the dangers of assuming that market forces, by themselves, will solve social problems. They will not.
She went further to say:
This world will never become a fair place by itself. Fairness, especially in matters of health, comes only when equity is an explicit policy objective. Universal coverage is a clear pursuit of equity and social justice. Universal coverage is also a powerful equaliser.
She continued by saying that:
... moving towards universal coverage is never easy, but every country, at every level of development, and with any level of resources, can take immediate and sustainable steps in that direction.
We have reached a point of no return on this issue of universal coverage through NHI. at 22 March 2012, I announced the names of NHI pilot districts on 10 sites. You remember them in all the districts. As was announced by the Minister of Finance, hon Pravin Gordhan, in Budget 2012, R1 billion has been allocated over the Medium-Term Expenditure Framework for purposes of supporting the pilots. When we launched the Green Paper in August 2011, we also unveiled the timetable of what should happen in the first five years of the NHI. On that day, I said that there were two preconditions that the country had to meet for the successful implementation of the NHI. The first precondition, as I said, was that the quality of health care in the Public Service had to improve tremendously and, hence, public health care needed to be overhauled. This overhaul, I said, was nonnegotiable. I also said that the second precondition was that pricing in the private health sector had to be regulated. I am repeating that today.
I am going to spend three days in each of the 10 pilot districts to meet various stakeholders and discuss these pilots. Piloting means doing all the things that are needed to meet these preconditions, especially the precondition dealing with the quality of service in the Public Service. We believe that within a five-year period, we will have covered the rest of the 52 districts of the country and will be able to march towards the 14- year period for implementing the NHI.
The success of the NHI also depends on certain basics in health care being adhered to. We need to understand that the main reason for the existence of any health care delivery system is to take care of the sick and the vulnerable. Health care delivery systems do not exist to create millionaires at the expense of the health of our people. This tendency of putting business before health - yesterday I called it a "tendercare system" because it is done in the form of tenders - is no longer a health care system but another form of uncontrolled commercialism, against which the WHO has warned us.
The manifestation of this tendency is the disappearance of funds meant for the most basic tenets of health care, through the nonpayment of pharmaceutical suppliers, resulting in shortages of medicines, vaccines, dry dispensary and other consumables. It also results in the nonpayment of laboratory services and blood supply services; shortages of equipment and devices for neonatal, perinatal and maternal services; and nonmaintenance of health infrastructure and equipment. I have agreed with the MECs that this must come to an end. To bring this to an end, we have termed these issues "nonnegotiables". We want to see these nonnegotiables being paid for every month, and we shall monitor it on a monthly basis.
The Budget includes new allocations of R97,6 million for the 2012-13 financial year, R619,4 million for 2013-14 and R1,4 billion for 2014-15. The allocations were divided as set out below.
An amount of R10 million per annum is provided for the forensic laboratories to purchase equipment and appoint staff to address backlogs. We recently appointed 70 unemployed graduates with degrees in chemistry, biochemistry and chemical engineering in order to improve the performance and turnaround times of the forensic laboratories.
Provision has been made for amounts of R9 million, R10,3 million and R11 million to establish a unit to monitor and support provincial finances and improve audit outcomes. As part of the support to the provinces to improve the audit outcomes, the department has appointed 100 unemploymed graduates with BCom degrees to undergo an internship programme.
The department is requesting this august House to support the allocation for Vote No 16: Health, amounting to R27,6 billion for the year 2012-13 and growing to R33,9 billion over the MTEF in the 2014-15 financial year.
In conclusion, I wish to thank everybody who contributed to the success of this department: the Deputy Minister, Dr Gwen Ramokgopa, with whom we worked tirelessly to make sure that we shared the functions; the director- general, Ms Precious Matsoso, and her team; all the structures from the South African National Aids Council, which helped us with the national strategic plan; the office of the Deputy President and the Deputy President himself for chairing Sanac and guiding us in the fight against the scourge of HIV/Aids; the health-related unions; our development partners; and everybody else involved because, as you know, our slogan is that if we work together, we will achieve more. I thank you. [Applause.]
MR M B GOQWANA: Chairperson, Minister and other Ministers present, hon Deputy Minister and other Deputy Ministers present, the director-general and her team; the MECs who are here; I have noticed that the Board of Healthcare Funders is here; as are representatives from the Council for Medical Schemes, the Hospital Association of South Africa, the Health Professions Council of South Africa and the SA Medical Research Council - I acknowledge all of you, Members of Parliament, ladies and gentlemen.
I am not going to take a long time, but I want to start by saying that at this second half of our term in Parliament, my response to this budget speech on health will focus on oversight. We have been voting on funds for the Department of Health, trusting that the deployees are going to transform the department so that it improves life expectancy in a qualitative and quantitative manner.
I always ask myself: Who sets the agenda in any given situation? In this instance, who sets the health agenda of South Africa? I stand here without fear of contradiction and say that, under the leadership of Dr Aaron Motsoaledi, it is very clear that there is the passion and zeal to come up with solutions to pressing health issues.
However, I must say with sadness that I have noted that this passion and zeal have not filtered through to some of the provinces ...